Department of Public Health and Clinical Medicine, Umeå Stroke Centre, Umeå University, Umeå, Sweden.
Int J Stroke. 2013 Jun;8(4):220-7. doi: 10.1111/j.1747-4949.2012.00790.x. Epub 2012 Apr 12.
Carotid endarterectomy yields greater risk reduction for ipsilateral ischemic stroke when performed within two-weeks of the last cerebrovascular symptom than when performed two-weeks or more after the last symptom. However, additional benefit might be gained if carotid endarterectomy is performed earlier than within two-weeks.
To investigate the 90-day risk of ipsilateral ischemic stroke recurrence after amaurosis fugax, retinal artery occlusion, transient ischemic attack, or minor ischemic stroke in patients with 50-99% carotid stenosis before carotid endarterectomy, with emphasis on the first 14 days.
Prospective cohort study. 230 consecutive patients with symptomatic 50-99% carotid stenosis (North American Symptomatic Carotid Endarterectomy Trial grading method) who underwent evaluation before carotid endarterectomy. Of these, 183 underwent carotid endarterectomy; the median delay to carotid endarterectomy was 29 days. Blood pressure lowering medication was used by 93% and lipid-lowering medication by 90%.
The risk of ipsilateral ischemic stroke recurrence before carotid endarterectomy was 5·2% (n = 12) within two-days, 7·9% (n = 18) within seven-days, 11·2% (n = 25) within 14 days, and 18·6% (n = 33) within 90 days of the presenting event. The risk of ipsilateral ischemic stroke recurrence was higher if the presenting event was a stroke (adjusted hazard ratio 12·4, P = 0·015) or transient ischemic attack (adjusted hazard ratio 10·2, P = 0·026) compared with an amaurosis fugax.
The risk of recurrent ipsilateral ischemic stroke was high within the first days of the presenting event. Many recurrences would likely have been avoided if carotid endarterectomy had been performed within the first days of the presenting event.
与最后一次脑血管症状发生后两周或更长时间进行颈动脉内膜切除术相比，在最后一次脑血管症状发生后两周内进行颈动脉内膜切除术可显著降低同侧缺血性卒中的风险。然而，如果颈动脉内膜切除术的时间早于两周内，可能会获得额外的益处。
调查在颈动脉内膜切除术之前患有 50-99%颈动脉狭窄的患者中，短暂性脑缺血发作、视网膜动脉阻塞、短暂性脑缺血发作或小卒中后出现一过性黑矇的同侧缺血性卒中复发的 90 天风险，重点关注前 14 天。
前瞻性队列研究。230 例有症状的 50-99%颈动脉狭窄患者（北美症状性颈动脉内膜切除术试验分级方法）在颈动脉内膜切除术之前接受评估。其中 183 例患者接受了颈动脉内膜切除术；颈动脉内膜切除术的中位延迟时间为 29 天。93%的患者使用降压药物，90%的患者使用降脂药物。
在颈动脉内膜切除术之前，同侧缺血性卒中复发的风险在 2 天内为 5.2%（n=12），7 天内为 7.9%（n=18），14 天内为 11.2%（n=25），90 天内为 18.6%（n=33）。如果首发事件为卒中（调整后的危险比 12.4，P=0.015）或短暂性脑缺血发作（调整后的危险比 10.2，P=0.026），同侧缺血性卒中复发的风险高于一过性黑矇。
首发事件发生后的最初几天内，同侧缺血性卒中复发的风险很高。如果在首发事件发生后的最初几天内进行颈动脉内膜切除术，可能会避免许多复发。
